1/5. Double-chambered right ventricle associated with mural and pulmonic valve endocarditis: description of a clinical case and review of the literature.A double-chambered right ventricle is a relatively uncommon congenital cardiac defect characterized by the presence of anomalous muscle bundles dividing the right ventricle into a high-pressure proximal chamber and a low-pressure distal chamber. This pathology is often wrongly diagnosed in adult patients. We report the first case of a patient with double-chambered right ventricle associated with a mural and pulmonic valve endocarditis caused by streptococcus parasanguis diagnosed with two-dimensional echocardiography. During the course of treatment, the patient suffered from a septic pulmonary embolism, and subsequently required surgical intervention, which confirmed the echocardiographic findings.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/5. Successful adult-to-adult living donor liver transplantation in a patient with moderate to severe portopulmonary hypertension.Portopulmonary hypertension (PPHTN) is one of the most devastating consequences of end-stage liver cirrhosis. When a patient has moderate to severe PPHTN, his or her candidature for liver transplantation is denied. Here we report a successful adult-to-adult living donor liver transplantation (LDLT) in a patient with moderate to severe PPHTN. The patient was a 58-yr-old female who was diagnosed with end-stage liver cirrhosis due to chronic hepatitis c. Preoperative evaluation revealed that the patient had moderate to severe PPHTN. Her mean pulmonary artery pressure (mPAP) was 35-47 mmHg without treatment. Continuous epoprostenol therapy was introduced to lower the mPAP. She underwent LDLT using an extended right hepatic lobe graft which was donated by her daughter. Prolonged artificial ventilation was necessary until postoperative day (POD) 25, after which her general condition gradually improved. By POD 72, she was in good condition and was allowed to leave the hospital. Currently, 1 yr after the operation, she visits the outpatient clinic regularly and enjoys a normal life. It should be noted, however, that the PPHTN markedly improved but did not completely resolve, as assessed by right heart catheterization 1 yr after successful LDLT.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/5. MRI and CT findings of the giant cell tumors of the skull; five cases and a review of the literature.PURPOSE: To investigate CT and MR findings of giant cell tumors (GCTs) of the skull, an unusual site for such tumors. MATERIALS AND methods: CT and MR features of five histologically proven giant cell tumors of the skull were retrospectively reviewed. We also reviewed 22 cases in the literature that included MR or CT findings. RESULTS: Three of the tumors originated from the temporal bone with predominantly medial extension, and the other two were centered in the body of the sphenoid bone and featured symmetrical soft tissue extension. CT images with bone window settings showed reactive bone changes for all three tumors of the temporal bone, suggesting slow growth for example, an expanded intradiploic space, expansive remodelling and development of foci of pressure erosion. GCTs of the sphenoid bone showed purely osteolytic changes without remodelling. Although the MR signals and enhancement patterns varied, all the tumors of the temporal bone had a markedly low intensity area on T2-weighted images, which was not seen in the tumors of the sphenoid bone. The findings for our cases generally corresponded to those reported in the literature. CONCLUSION: giant cell tumors of the skull have two preferential sites and may have characteristic tendencies as to their extent. Bone changes and MR signals appear to show differences between the two sites.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/5. Orbital subperiosteal hemorrhage while scuba diving.PURPOSE: To report an uncommon case of unilateral subperiosteal hemorrhage while scuba diving involving the orbit, a condition characterized by proptosis and associated severe ocular motility disturbances with displacement of the eyeball. MATERIAL AND methods: Observational case report. RESULTS: Unilateral subperiosteal hemorrhage in a 31-year-old woman while scuba diving at a depth of 20 meters. This was documented by clinical and radiographic examination. Computed tomography (CT) scan demonstrated a subperiosteal hemorrhage as a self-limited mass protruding into the left orbit. The process resolved without treatment and without visual or motility sequelae. A CT-scan, nuclear magnetic resonance, and conventional angiography did not show any venous abnormalities in the brain. CONCLUSION: During scuba diving at a depth of 20 meters, the pressure is three atmospheres, whereas within the diving mask the pressure is one atmosphere if it is not equilibrated; thus, a negative pressure is created within the mask. Small vessels can be broken in the conjunctiva or subperiosteal space by this force. It is important to exclude vascular abnormalities, especially if there is a positive family history.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
5/5. baroreflex failure: a rare complication of carotid paraganglioma surgery.Multiple head and neck paragangliomas are a rare occurrence. We report a patient with removal of bilateral carotid paragangliomas who subsequently developed baroreflex failure 1 month after surgery. The pathology and physiology of this presentation is extremely interesting because it exhibits the complex homeostatic mechanisms involved in the maintenance of steady-state blood pressure. Although rare, it is important to be aware of baroreflex failure and its variable course. Most postsurgical cases occur within days of surgery but, as this report demonstrates, hypertensive urgency can occur weeks to months after surgery; and if not recognized early, it can lead to disastrous postoperative complications such as stroke and myocardial infarction.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |